On your own and in hospital - what you NEED to know...

So it's been a while since I've blogged... holiday + trauma = lack of motivation. I wound up in hospital last month, one of those emergency admissions where private health insurance makes no difference. All I could do is take myself to the nearest public hospital as quickly as possible... and let the chips fall where they may.

Much as terrible things have been written about North Shore Hospital, I found the team in admissions to be excellent... yet as the days wore on, I came to realise it was more about me than them. I was pleasant and so were they, but I wasn't screaming - so I couldn't be a priority. Years ago a doctor in Auckland Hospital told me to consider myself lucky that I wasn't in the third world, "where the one who screams the loudest gets the operation". Nice! But I realised too late this time around, that advice was a huge clue as to how modern day hospitals operate.

What's this got to do with being single? It took me five days to work it out. Seemingly everyone else had people who were prepared to scream when they couldn't. Admissions did communicate with me brilliantly - they were really busy, would get to me as soon as possible, were very sorry... but the bottom line was that I was not screaming! I was not screaming for 5 hours. I was vomiting, my bowel was obstructed (which is a special kind of pain) but I was not screaming and most importantly - nobody was screaming for me... so I waited like a good girl for my turn.

As single adults, we learn to manage difficult situations on our own regularly. We tend to be resourceful and keep it together. Single people can't let themselves lose the plot, especially when they're at their most vulnerable. If all the king's horses and all the king's men couldn’t do it, we know we can't do it on our own, so we're better off not falling off the wall in the first place. Think about the elderly single people in Christchurch and Japan who waited days for help, alone and stoic. It's not just a post war phenomenon. Years of being on your own makes you very self-sufficient.

Yet as a single person you have to understand that being on your own and being in hospital are two different things. In hospital, you need to fight for your share of resources because you are not alone. Here, you have to rely on others in a way you don't in any other part of your life; here you can be ignored and mistreated. This is why hospital is one place where you need an advocate. You need a layperson on your side to fight for you, because the staff will not. To them, you're just a shift and a set of symptoms. That they know what they're doing means you don't have to. The less information they give you, the better to keep you from questioning or arguing and the least chance of being in trouble themselves.

I experienced more pain, confusion, humiliation, tears and fear in five days than I have in my whole 40 years. I learned the public system is not there for you, the patient. It's there for the education and edification of doctors and nurses who treat you as a transient trespassing commodity usurping their precious time. You are a case study. There is no privacy, no dignity, no accountability and no kindness. You will be treated like a slightly deaf, truculent child whose very pain is your own fault!

Twice a day (except on Sundays), a group of 'doctors' will appear at your bedside. There may be one but often 5-6. They don't all speak to you. You won't know who they are or anything about their relevance to your case, experience or hierarchy. Typically none of them will introduce themselves - you don't need to know who they are after all, you're just a patient. They will spend a few minutes and then leave. If you happen to be near the ward reception you will often hear them telephone some specialist to update them. This is a good thing as you'll overhear more details than you will be given directly. Of course, if you're not in earshot, you'll remain in the dark - as they seem to prefer it.

You may ask questions but the answers will be short. The nurses will tell you to ask the doctors. The doctors will give you the briefest response, which is likely to be inconsistent with what you've already been told. As one 'doctor' (who knows who he was?) told me "If you ask 10 doctors, you'll get 10 different responses" - hardly useful, reassuring or accountable. You can take comfort in that fact that you'll hear every other patient in earshot be given the same rude treatment. It's not personal - it's just not personal. You stopped being a person the minute that hospital gown went on. I know, one doctor saw me in civilian clothes the day before I was discharged (I was hoping I could "fake it" out of the hospital). His comment to me was - you guessed it; "wow, you look like...”. I said "...a normal person?". He laughed and agreed. Nuff said! 

In the first ward, I was next to a patient who demanded, yelled, complained, swore and all the rest. While he was being taken elsewhere I also got to hear the staff discuss him - how his attitude was not doing him any favours in terms of his care. He too was alone. His only visitor a pity stop from a near stranger. When a day later I too wanted to swear, demand and scream, I was too afraid to do so. You are at their mercy - completely. While single people are usually good at standing up for themselves (there's no-one else to do it) I learned that hospital is not the place to put that into practice. A squeaky wheel may well get the oil... but it could be administered via the backside, or worse!

So if the clue is in screaming the loudest, it's only a clue. The real answer is to have someone scream for you, and if there's no-one, then you need to utilise all that single self-sufficiency in a way that will work for you.

Here's my advice:

1. Get an advocate- a friend, family member, neighbour - it doesn't matter who but get someone to visit!

The one thing you most need in hospital is an advocate. Someone who can ask questions, insist on answers and protect you. A reminder to the staff that you're a person, not just a hospital gown. You can apologise for their rudeness, play the good cop to their bad but you'll get more information and better results with their advocacy. This only works during visiting hours however, so the second thing you need is a notebook and a pen.

2. Take a notebook and pen and write EVERYTHING down and use your phone camera!

Nighttimes are the worst! Make notes, note everything. If you're on drugs, your memory can fail you. If you're not hyper medicated, the stress and sleeplessness will play tricks on you. WRITE EVERYTHING DOWN. Note names (if you can get them) times, details... and take photos of anything you are worried about. You may not have a complaint but you may have questions and you'll need details. If you have a complaint later, you'll need details. I repeat, your memory will fail you - write it down, take photos, collect evidence. (I didn't have a notebook so I used the pages in the back of the novel I was reading.)

3. Let the staff see you making notes!

It won't hurt for the staff to see you writing notes, taking photos with your phone etc... It might help keep them accountable if they know they're on record. Think of it like a security sticker on your house; if a burglar is passing they're less likely to pick you. Equally if the hospital staff see you making notes, they are less likely to slip up in front of YOU. Hey, you can be pleasant about it. Tell them you're just documenting your recovery because you've always been fascinated by medicine. Don't threaten them, but let them gently become aware that you're watching and recording what's going on.

4. Understand that you are not in a black and white world, and learn to reconcile shades of grey!

Hearing different information is really unsettling. You're scared, sore, weak and you want to know exactly what you have to do to get out of there. Face it - different staff will give you different information and some will be more experienced, better informed, and more effectively communicative than others. Your case will be different from the person in the next bed. When you get differing and confusing information write down the question and get the info from the doctor on the next rounds. Ask for parameters if they won't give you a simple answer. Ask for information in layman's terms if they babble medical-speak at you. Insist (nicely) but have your notebook handy, and write the answer down!

5. Take some comfort in that everyone is equal on the ward!

On my last evening in the ward, a new post-surgery patient arrived and we had a chat. She too was there by herself (rang her kids to check on them, and they her). I had a bit of a moan in response to her questions. She turned out to be part of the medical fraternity as I discovered later that night our ward nurse asked my new ward mate for some medical advice about her pregnancy. They had a good wee chat. Come morning though the patient / doctor was "uncomfortable" and by mid morning, our newly on-shift ward nurse had called the specialist twice as the patient's pain was clearly beyond what she'd expected and could manage. That morning we were lucky that our ward nurse was one of the best I met. She wasn't currying favour for a medical colleague; she was just doing her best job as she would have done for any of us- if only all nurses were as good! I was discharged so I can only hope that the my ward mate quickly thereafter got the pain relief she needed.

We single people know how to get the results we need, and while hospital is painful and unpleasant it is not the place to drop our game. We all know that doctors and nurses are people too, with good and bad days, and varying personalities. No doubt many of them work too hard for too little reward. There is no preferential treatment (though you might receive specially horrible treatments) - we're all equal in hell or hospital it seems. The bottom line is that hospital for a single person is terrifying and you need to do what it takes to get yourself through it in the best way possible. You cannot rely on the kindness of strangers - just count yourself lucky for the really great nurses and doctors if/ when you get them. It is up to you to take care of you, in hospital... as always!